K Number
K022558
Device Name
NGT
Date Cleared
2003-07-08

(340 days)

Product Code
Regulation Number
876.5980
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The NGT is intended for gastric decompression, gastric suction, administration of nutritional supplements and medication, and to monitor core temperature.

Device Description

The NGT Nasogastric Tube is made of a plastic material, contains three lumens, a main suction lumen, a smaller vent lumen, and a still smaller temperature thermistor lumen. The primary suction lumen is used for drainage, the second vent lumen provides an air inlet as a mechanism to break suction minimizing the potential for tube blockage secondary to mucosal tissue invagination into the side holes of the primary lumen. The device is intended to be used with a standard suction source to facilitate drainage.

AI/ML Overview

The provided 510(k) summary for K022558 focuses on demonstrating substantial equivalence of the NGT Nasogastric Thermistor device to predicate devices. It states that "Bench testing was performed on the NGT to demonstrate equivalency." However, the summary does not provide any specific acceptance criteria or detailed results of this performance testing.

Therefore, I cannot populate the table or answer most of the questions as the required information is not available in the given text.

Here's a breakdown of what can be extracted and what cannot:

1. Table of Acceptance Criteria and Reported Device Performance:

Acceptance CriteriaReported Device Performance
NOT PROVIDEDNOT PROVIDED
No specific performance metrics, thresholds, or results are mentioned in the document.The document only states "Bench testing was performed... to demonstrate equivalency," without detailing what equivalency entailed in terms of specific performance measures.

2. Sample size used for the test set and the data provenance:

  • Sample size: Not provided.
  • Data provenance: Not provided (the document only mentions "Bench testing," which implies laboratory-based testing, but no details on data origin or type are given).

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

  • Not applicable. This device is a medical tube with a temperature sensor, not an AI/Software as a Medical Device (SaMD) requiring expert-established ground truth for interpretation of images or other complex data. The document describes bench testing for equivalency, not a study involving expert review of results.

4. Adjudication method for the test set:

  • Not applicable. (See answer to #3)

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

  • Not applicable. This is not an AI/SaMD device.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done:

  • Not applicable. This is a physical medical device, not an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc):

  • Not applicable in the conventional sense for a physical device. For "bench testing," ground truth would typically refer to known physical properties, measurements from calibrated reference instruments, or specified performance standards for gastric suction and temperature sensing. The document does not specify these.

8. The sample size for the training set:

  • Not applicable. This is a physical medical device, not an machine learning model requiring a training set.

9. How the ground truth for the training set was established:

  • Not applicable. (See answer to #8)

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K022558
1 of 1

510K Summary of Safety and Effectiveness April 7, 2003

JUL 0 8 2003

  • Sponsor Name 1.

Medical Innovative Products 205 Roval Oak Ave. Pittsburgh, PA 15235 Telephone: (412)-244-9205 Contact Individual: Michael Swartz

  • Device Name Proprietary Name: NGT Nasogastric Thermistor Common/Usual Name: Nasogastric Tube
    1. Identification of Predicate or Legally Marketed Device
    • Bard Nasogastric Sump Tube manufactured by C.R. Bard cleared under K960176 .
    • Arqyle Salem Sump Tube manufactured by Sherwood Medical cleared under K935781 .
    • Mon-a-therm Esophageal Stethoscope with temperature sensor manufactured by . Mallinckrodt cleared under K914887
  • Device Description 4.

The NGT Nasogastric Tube is made of a plastic material, contains three lumens, a main suction lumen, a smaller vent lumen, and a still smaller temperature thermistor lumen. The primary suction lumen is used for drainage, the second vent lumen provides an air inlet as a mechanism to break suction minimizing the potential for tube blockage secondary to mucosal tissue invagination into the side holes of the primary lumen. The device is intended to be used with a standard suction source to facilitate drainage.

    1. Intended Use
      The NGT is intended for gastric decompression, gastric suction, administration of nutritional supplements and medication, and to monitor core temperature.
    1. Comparison of Technological Characteristics
      The NGT Nasogastric Tube has similar technological characteristics to the Bard Nasoqastric Sump Tube and the Argyle Salem Sump Tube in that the materials are the sizes available are within the range of sizes currently available, but the NGT Nasogastric Tube incorporates a temperature monitoring capability. This temperature monitoring capability is similar to the Mallinckrodt Mon-a-therm Esophageal Stethoscope with temperature sensor. However, the NGT Nasogastric Tube incorporates this temperature thermistor into a third lumen whereas the other predicates all have 2 lumens.

The differences in the configurations of each of the devices do not affect the ability of the device to suction gastric fluids. Each of the devices requires monitoring by the clinical staff to assure proper nasogastric tube function. Each of the devices uses the same operating principal.

7 Performance Testing

Bench testing was performed on the NGT to demonstrate equivalency.

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Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 0 8 2003

Medical Innovative Products c/o Ms. Debbie Iampietro ORC Consulting 7 Tiffany Trail HOPKINTON MA 01748

Re: K022558

Trade/Device Name: NGT NasoGastric Thermistor Regulation Number: 21 CFR §876.5980 Regulation Name: Gastrointestinal tube and accessories Regulatory Class: II Product Code: 78 KNT Dated: April 7, 2003 Received: April 9, 2003

Dear Ms. Iampietro:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

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This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of the letter:

8xx.1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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KO22558 510(k) Number (if known): __________________________________________________________________________________________________________________________________________________

Device Name: NGT Nasogastric Thermistor

Indications For Use:

The NGT is intended for gastric decompression, gastric suction, administration of nutritional supplements and medication, and to monitor core temperature.

(PLEASE DO NOT WRITE BELOW THIS LINE. CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use
(Per 21 CFR 801.109) ✓

OR

Over-The-Counter Use ________________________________________________________________________________________________________________________________________________________

David R. Logsdon

(Division Sign-Off) Division of Reproductive and Radiological Dev 510(k) Number

§ 876.5980 Gastrointestinal tube and accessories.

(a)
Identification. A gastrointestinal tube and accessories is a device that consists of flexible or semi-rigid tubing used for instilling fluids into, withdrawing fluids from, splinting, or suppressing bleeding of the alimentary tract. This device may incorporate an integral inflatable balloon for retention or hemostasis. This generic type of device includes the hemostatic bag, irrigation and aspiration catheter (gastric, colonic, etc.), rectal catheter, sterile infant gavage set, gastrointestinal string and tubes to locate internal bleeding, double lumen tube for intestinal decompression or intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube with mercury weight balloon for intestinal intubation or decompression, and gastro-urological irrigation tray (for gastrological use).(b)
Classification. (1) Class II (special controls). The barium enema retention catheter and tip with or without a bag that is a gastrointestinal tube and accessory or a gastronomy tube holder accessory is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I (general controls) for the dissolvable nasogastric feed tube guide for the nasogastric tube. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 876.9.